Laparoscopic pyeloplasty: experience with the initial 30 cases.

PURPOSE: We assessed the intermediate effectiveness of laparoscopic pyeloplasty in the treatment of the obstructed ureteropelvic junction.

MATERIALS AND METHODS: A total of 30 pyeloplasties was performed for symptomatic ureteropelvic junction obstruction (24 primary and 6 secondary cases). Two separate types of reconstruction were performed, that is dismembered (26 patients) and Y-V (4) pyeloplasty. All patients were followed with excretory urography or diuretic renography. Moreover, factors affecting the learning curve (surgical technique, prior laparoscopic experience and cause of obstruction) were evaluated.

RESULTS: A lower pole segmental renal vessel was found at the ureteropelvic junction in 18 patients (60%). Operative time ranged from 2.25 to 8.0 hours (mean 4.5). Postoperative morbidity (mean narcotic requirement 37.3 mg. morphine sulfate, mean hospital stay 3.5 days and convalescence 3 weeks) was minimum. At radiographic followup (mean 16.3 months, range 4 to 73) 97% of the patients demonstrated a patent ureteropelvic junction and resolution of or substantial decrease in hydronephrosis.

CONCLUSIONS: In the hands of an experienced laparoscopist, outcomes indicate that laparoscopic pyeloplasty shows success similar to that of open pyeloplasty but longer term outcomes must be assessed.